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Polymorphisms at CYP enzymes, NR1I2 and NR1I3 in association with virologic response to antiretroviral therapy in Brazilian HIV-positive individuals. THE PHARMACOGENOMICS JOURNAL 2022; 22:33-38. [PMID: 34504302 DOI: 10.1038/s41397-021-00254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/17/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Virologic failure of antiretroviral therapy (ART) may be explained by single nucleotide polymorphisms (SNPs) in drug absorption and metabolism genes. Here, we characterized the associations between polymorphisms in cytochrome P450 enzymes' genes CYP2B6 and CYP3A4/A5, nuclear receptor genes NR1I2/3, and initial ART efficacy among 203 HIV-positive individuals from Rio de Janeiro. Association between SNPs and virologic control was evaluated after 6 and 12 months of follow-up using Cox regression models. The SNP rs2307424 (NR1I3) was associated with increased virologic response after 12 months of treatment, while rs1523127 (NR1I2), rs3003596, and rs2502815 (NR1I3) were associated with decreased response. Increased virologic response after 12 months (adjHR = 1.54; p = 0.02) was also observed among carriers of the NR1I3 haplotype rs2502815G-rs3003596A-rs2307424A versus the reference haplotype G-A-G. Our results suggest that NR1I2 and NR1I3 variants are associated with virologic responses to ART among Brazilians.
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de Almeida TB, de Azevedo MCVM, Pinto JFDC, Ferry FRDA, da Silva GAR, de Castro IJ, Baker P, Tanuri A, Haas DW, Cardoso CC. Drug metabolism and transport gene polymorphisms and efavirenz adverse effects in Brazilian HIV-positive individuals. J Antimicrob Chemother 2018; 73:2460-2467. [PMID: 29868865 PMCID: PMC6105872 DOI: 10.1093/jac/dky190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/13/2018] [Accepted: 04/22/2018] [Indexed: 01/11/2023] Open
Abstract
Objectives There are limited data regarding efavirenz pharmacogenetics in admixed populations. The Brazilian population is highly admixed. In a Brazilian cohort, we sought to characterize associations between efavirenz adverse effects (all-cause and CNS) and polymorphisms in seven genes known or suspected to affect efavirenz metabolism and transport. Methods We studied 225 HIV-positive individuals who had been prescribed efavirenz-containing regimens at a hospital in Rio de Janeiro, Brazil. Eighty-nine cases had efavirenz adverse effects, including 43 with CNS adverse effects, while 136 controls had no adverse effect of any antiretroviral after treatment for at least 6 months. A total of 67 candidate polymorphisms in ABCB1, CYP2A6, CYP2B6, CYP3A4, CYP3A5, NR1I2 and NR1I3 genes were selected for association analysis. Admixture was assessed using 28 ancestry-informative polymorphisms previously validated for the Brazilian population. Associations were evaluated with logistic regression models adjusted for sex and genetic ancestry. Results There was extensive African, European and Native American admixture in the cohort. Increased all-cause adverse effects were associated with the CYP2B6 genotype combination 15582CC-516TT-983TT (OR = 7.26, P = 0.003) and with the CYP2B6 slow metabolizer group 516TT or 516GT-983CT (OR = 3.10, P = 0.04). CNS adverse effects were nominally associated with CYP3A4 rs4646437 (OR = 4.63, P = 0.014), but not after adjusting for multiple comparisons. Conclusions In a highly admixed Brazilian cohort, the CYP2B6 slow metabolizer genotype was associated with an increased risk of efavirenz adverse effects.
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Affiliation(s)
- Tailah Bernardo de Almeida
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Jorge Francisco da Cunha Pinto
- Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | | | - Izana Junqueira de Castro
- Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Paxton Baker
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - David W Haas
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Meharry Medical College, Nashville, TN, USA
| | - Cynthia C Cardoso
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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[Survival in HIV-1 patients receiving antiretroviral therapy in Morocco]. Rev Epidemiol Sante Publique 2018; 66:311-316. [PMID: 30177238 DOI: 10.1016/j.respe.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose was to study factors associated with the survival of HIV-1 patients receiving antiretroviral therapy in Morocco. MATERIAL AND METHOD This was a retrospective study of a cohort of 182 HIV-1 patients receiving antiretroviral therapy in the department of dermatology venereology at the Military Instruction Hospital Mohamed V in Rabat during the period from 1 January 2006 to 1 January 2017. Death of any cause during the study period was considered to be the result of HIV infection. The log-rank test was used to compare the survival curves based on determinants. The Cox regression model analyzed the determinants of survival since induction of antiretroviral therapy. RESULTS The median follow-up time was 4.7 years (IQR: 1.97-8.18). The mortality rate was 75 deaths per 1000 person-years. Advanced clinical stage CDC C (RR: 2.72; CI 95%: 1.33-5.56) and treatment with indinavir (RR: 1.41; CI 95%: 0.77-2.59) were significantly associated with death. CONCLUSION Initiation of antiretroviral therapy in the early stage of the disease and use of less toxic molecules are recommended to reduce mortality.
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Arruda MB, Campagnari F, de Almeida TB, Couto-Fernandez JC, Tanuri A, Cardoso CC. Single Nucleotide Polymorphisms in Cellular Drug Transporters Are Associated with Intolerance to Antiretroviral Therapy in Brazilian HIV-1 Positive Individuals. PLoS One 2016; 11:e0163170. [PMID: 27648838 PMCID: PMC5029869 DOI: 10.1371/journal.pone.0163170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/02/2016] [Indexed: 01/11/2023] Open
Abstract
Adverse reactions are the main cause of treatment discontinuation among HIV+ individuals. Genes related to drug absorption, distribution, metabolism and excretion (ADME) influence drug bioavailability and treatment response. We have investigated the association between single nucleotide polymorphisms (SNPs) in 29 ADME genes and intolerance to therapy in a case-control study including 764 individuals. Results showed that 15 SNPs were associated with intolerance to nucleoside and 11 to non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs), and 8 to protease inhibitors (PIs) containing regimens under alpha = 0.05. After Bonferroni adjustment, two associations remained statistically significant. SNP rs2712816, at SLCO2B1 was associated to intolerance to NRTIs (ORGA/AA = 2.37; p = 0.0001), while rs4148396, at ABCC2, conferred risk of intolerance to PIs containing regimens (ORCT/TT = 2.64; p = 0.00009). Accordingly, haplotypes carrying rs2712816A and rs4148396T alleles were also associated to risk of intolerance to NRTIs and PIs, respectively. Our data reinforce the role of drug transporters in response to HIV therapy and may contribute to a future development of personalized therapies.
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Affiliation(s)
- Mônica Barcellos Arruda
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Tailah Bernardo de Almeida
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Cynthia Chester Cardoso
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- * E-mail:
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Hoffmann M, MacCarthy S, Batson A, Crawford-Roberts A, Rasanathan J, Nunn A, Silva LA, Dourado I. Barriers along the care cascade of HIV-infected men in a large urban center of Brazil. AIDS Care 2015; 28:57-62. [PMID: 26291264 DOI: 10.1080/09540121.2015.1062462] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.
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Affiliation(s)
- Michael Hoffmann
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Sarah MacCarthy
- b RAND Corporation , 1776 Main Street, Santa Monica , CA 90407 , USA
| | - Ashley Batson
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Ann Crawford-Roberts
- c Icahn School of Medicine at Mount Sinai , 1428 Madison Ave, New York , NY 10029 , USA
| | - Jennifer Rasanathan
- d Department of Family and Social Medicine , Montefiore Medical Center , 111 East 210th Street, Bronx , NY 10467 , USA
| | - Amy Nunn
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Luis Augusto Silva
- e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil
| | - Ines Dourado
- e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil
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Valentini MB, Toledo MLGD, Fonseca MO, Thiersch LMS, Toledo ISBD, Machado FCJ, Tupinambás U. Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010. Braz J Infect Dis 2015; 19:253-62. [PMID: 25769736 PMCID: PMC9425387 DOI: 10.1016/j.bjid.2015.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 11/05/2022] Open
Abstract
Introduction Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients’ survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated. Methods A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm3 or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm3 or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods. Results Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm3 (IQR: 130–531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD. Conclusion The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed.
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Affiliation(s)
- Melissa Bianchetti Valentini
- Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Voluntary Counseling and Testing Site/Specialized Center in HIV Outclinic Patients Care (CTA-SAE), Belo Horizonte, MG, Brazil.
| | - Maria Luíza Guerra de Toledo
- National School of Statistical Science-Instituto Brasileiro de Geografia e Estatística (IBGE), Rio de Janeiro, RJ, Brazil
| | - Marise Oliveira Fonseca
- Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | | | | | - Unaí Tupinambás
- Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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De La Torre-Lima J, Aguilar A, Santos J, Jiménez-Oñate F, Marcos M, Núñez V, Olalla J, Del Arco A, Prada JL. Durability of the first antiretroviral treatment regimen and reasons for change in patients with HIV infection. HIV CLINICAL TRIALS 2014; 15:27-35. [PMID: 24518212 DOI: 10.1310/hct1501-27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To study the durability of the drugs and coformulations currently used in the first treatment regimen of antiretroviral therapy (ART) for HIV patients, and to examine the reasons for changing this medication. METHODS A retrospective observational multicenter study of patients with HIV infection who started a first-line ART regimen between January 2007 and June 2010. The primary outcome variable was the durability of this first ART regimen until discontinued or amended and the reasons for the change. Survival analysis of durability was performed using Kaplan-Meyer curves analysis, and a Cox multiple regression model was constructed to identify associated factors. RESULTS A first-line ART regimen was initiated for 600 patients; after 1 year, it had been changed in 172 (28%) cases, with a median duration of 31 months. The main reason for change was toxicity (20.5% of all patients), followed by loss to follow-up (8.3%) and virological failure (5.3%). The most common type of toxicity was gastrointestinal (30%), followed by cutaneous (23%) and neuropsychiatric (18%). The use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) was associated with greater durability than that of protease inhibitors (43 months vs 21 months; P = .001). CONCLUSIONS The durability of the first-line ART regimen, based on current antiretroviral drugs and coformulations, is about 2.5 years, with toxicity being the main reason for its modification. Gastrointestinal toxicity is the type most commonly reported. NNRTI treatment is associated with greater durability of the first treatment regimen.
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Affiliation(s)
- Javier De La Torre-Lima
- Infectious Disease Group, Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Ana Aguilar
- Infectious Disease Group, Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Jesus Santos
- Infectious Disease Department, Hospital Virgen de la Victoria, Málaga, Spain
| | | | - Miguel Marcos
- Infectious Disease Group, Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Victoria Núñez
- Infectious Disease Group, Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Julian Olalla
- Infectious Disease Group, Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Alfonso Del Arco
- Infectious Disease Group, Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
| | - Jose Luis Prada
- Infectious Disease Group, Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain
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Grangeiro A, Escuder MM, Cassanote AJF, Souza RA, Kalichman AO, Veloso V, Ikeda MLR, Barcellos NT, Brites C, Tupinanbás U, Lucena NO, da Silva CL, Lacerda HR, Grinsztejn B, Castilho EA. The HIV-Brazil cohort study: design, methods and participant characteristics. PLoS One 2014; 9:e95673. [PMID: 24789106 PMCID: PMC4006775 DOI: 10.1371/journal.pone.0095673] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 03/30/2014] [Indexed: 11/25/2022] Open
Abstract
Background The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART) and the impact of this treatment on morbidity, quality of life (QOL) and mortality. The study design, patients’ profiles and characteristics of cART initiation between 2003 and 2010 were described. Methodology/Principal Findings Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2–5.9 years) with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7∶1), with a mean age of 36.9 years (SD 9.9 years); 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4%) initiated cART with a CD4+ T-cell count ≤200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7%) and lopinavir/ritonavir (18.2%). The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1–78.6). Nearly half (45.4%) of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. Conclusions/Significance Results from cART use in the daily practice of health services remain relatively unknown in low- and middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient profile, which is similar to that of the AIDS epidemic in the country.
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Affiliation(s)
- Alexandre Grangeiro
- Department of Preventive Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- * E-mail:
| | | | - Alex Jones Flores Cassanote
- Postgraduate Program in Infectious and Parasitic Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rosa Alencar Souza
- STD/AIDS Referral and Training Centre, São Paulo State Department of Health, São Paulo, Brazil
| | - Artur O. Kalichman
- STD/AIDS Referral and Training Centre, São Paulo State Department of Health, São Paulo, Brazil
| | - Valdiléa Veloso
- Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria Letícia Rodrigues Ikeda
- Care and Treatment Clinic of the Partenon Sanatorium, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Nêmora Tregnago Barcellos
- Care and Treatment Clinic of the Partenon Sanatorium, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Carlos Brites
- Edgar Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil
| | - Unai Tupinanbás
- Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Noaldo O. Lucena
- Tropical Medicine Foundation, Amazonas State Department of Health, Manaus, Brazil
| | - Carlos Lima da Silva
- State Centre for Diagnosis, Treatment and Research, Bahia State Department of Health, Salvador, Brazil
| | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euclides Ayres Castilho
- Department of Preventive Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
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Palladino C, Briz V, Bellón JM, Climent FJ, de Ory SJ, Mellado MJ, Navarro ML, Ramos JT, Taveira N, de José MI, Muñoz-Fernández MÁ. Determinants of highly active antiretroviral therapy duration in HIV-1-infected children and adolescents in Madrid, Spain, from 1996 to 2012. PLoS One 2014; 9:e96307. [PMID: 24788034 PMCID: PMC4006876 DOI: 10.1371/journal.pone.0096307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/07/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents. DESIGN Multicentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t CoRISpeS-Madrid Cohort, Spain. METHODS Patients with a follow-up of ≥ 1 month spent on HAART, with available baseline CD4 count and HIV-viral load (VL) were included. Time spent on sequential HAART regimens was estimated and multivariable regression was used to identify predictors of time to first-line regimen discontinuation. RESULTS 104 patients were followed for a median 8 years after starting HAART among 1996-2012; baseline %CD4 was 21.5 (12.3-34.0)and viral load was 5.1 (4.6-5.6) log10 copies/mL. Patients received a mean of 1.9 regimens. Median time on first-line HAART (n = 104) was 64.5 months; second HAART (n = 56) 69.8 months; and third HAART (n = 21) 66.5 months. Eleven (11%) patients were lost to follow-up while on first-line HAART and 54% discontinued (cumulative incidence of 16% and 38% by 1 and 3-year, respectively). The main predictor of first-line regimen discontinuation was suboptimal adherence to antiretrovirals (AHR: 2.60; 95% CI: 1.44-4.70). CONCLUSIONS Adherence to therapy was the main determinant of the duration of the first-line HAART regimen in children. It is important to identify patients at high risk for non-adherence, such as very young children and adolescents, in provide special care and support to those patients.
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Affiliation(s)
- Claudia Palladino
- Instituto de Investigação do Medicamento (iMed. ULisboa), Faculty of Pharmacy, The University of Lisbon, Lisbon, Portugal
| | - Verónica Briz
- Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria “Gregorio Marañón”, Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - José María Bellón
- Unidad de Investigación, Fundación para la Investigación Biomédica, Hospital General Universitario “Gregorio Marañón”, Madrid, Spain
| | | | - Santiago J. de Ory
- Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria “Gregorio Marañón”, Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - María José Mellado
- Servicio de Pediatría, Hospital Universitario “Carlos III”, Madrid, Spain
| | - María Luisa Navarro
- Servicio de Pediatría, Hospital General Universitario “Gregorio Marañón”, Madrid, Spain
| | - José T. Ramos
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
| | - Nuno Taveira
- Instituto de Investigação do Medicamento (iMed. ULisboa), Faculty of Pharmacy, The University of Lisbon, Lisbon, Portugal
- Center of Interdisciplinary Investigation Egas Moniz (CiiEM), Institute of Health Sciences Egas Moniz, Caparica, Portugal
| | | | - María Ángeles Muñoz-Fernández
- Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria “Gregorio Marañón”, Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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